Provider Demographics
NPI:1558351593
Name:LARSON, JAMES EDWARD (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:LARSON
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 GUNBARREL RD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7184
Mailing Address - Country:US
Mailing Address - Phone:423-296-0407
Mailing Address - Fax:423-296-0174
Practice Address - Street 1:1829 GUNBARREL RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7184
Practice Address - Country:US
Practice Address - Phone:423-296-0407
Practice Address - Fax:423-296-0174
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000045031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics